Effects of norepinephrine on renal function in patients during
kidney transplantation surgery. Department of Anesthesiology, First
Hospital of Jilin University, Changchun 130021, China
Du Jinghui, Yao Di, Ma Haichun
Corresponding author:
Ma Haichun (e-mail: mahaichun2003@yahoo.com.cn)
[Abstract] Objective: To test whether norepinephrine infusion at
0.01 ～ 0.4µg·kg·min adversely affect graft function for patients
undergoing kidney transplantation surgery. Methods: 32 patients with
ASA III~IV, aged 22～64yr, weight 44～88kg and no history of heart
failure undergoing allograft renal transplantation were studied. Daily
blood pressure was controlled relatively stable. Combined spinal-epidural
anesthesia(CSEA) was elected. Spinal anesthesia was performed at the
L2～L3 interspace and hyperbaric 0.5% bupivacaine(10～15mg) was
administered into the subrachnoid space. A sensory block to pinprick to
T6. Epidural catheter was placed at the T11～T12 and 1% ropivacaine
was given intermittently to maintain anesthesia. The patients were
randomly allocated into 2 groups(n=16)：D group intravenously received
1～10µg·kg·min dopamine, while N group intravenously received
0.01 ～ 0.4µg·kg·min norepinephrine when the blood pressure
decreased by 10% of preanesthetic blood pressure before release of the
graft vessel clamps. The patients were sedated with midazolam 1mg and
continuous infusion of propofol at 2～4mg·kg·h during surgery. ECG,
IBP, CVP, HR and SPO2 were continuously monitored. SBP, DBP, MAP,
CVP, HR and SPO2 were recorded before anesthesia(T0)，before release
of the graft vessel clamps(T1), 10min after release of the graft vessel
clamps(T2) and at the end of surgery(T3). Peripheral vein blood and urine
samples were obtained at the end of surgery(T3) and the twelfth
postoperation hour(T4) for determination the concentration of serum
Cystatin
C,
β-microglobubin
and
urine
α-microglobubin,
β-microglobubin. Urine volume was also recorded at the end of
surgery(T3) and the twelfth postoperation hour(T4). Meanwhile , the
frequency of furosemide used in twelve hours postoperation was
memorized. Results: The two groups were comparable with respect to
age, M/F sex radio, weight, operation time and volume of fluid infused.
The hemodynamics was stable in each group and no adverse event was
observed in any patient during surgery. At T3, the concentrations of
serum Cystatin C, β-microglobubin and urine α-microglobubin,
β-microglobubin
in
both
groups
were
no
significance
of
difference(P>0.05). At T4, the concentrations of serum Cystatin C,
β-microglobubin and urine α-microglobubin, β-microglobubin in both
groups were no significance of difference(P>0.05). The urine volume at
the end of surgery in group N compared with group D increased a lot, but
there was no statistic meaning in both groups (P>0.05). The urine volume
in postoperation 12h and the frequence of furosemide used in both groups
were no statistic meaning(P>0.05). Conclusion: It’s feasible that
0.01~0.4µgkgmin norepinephrine was injected intravenously during
kidney transplantation surgery. Norepinephrine proved equivalent to
dopamine in every measured respect. Specially, it has no bad influence on
graft function recovery.
Keywords: norepinephrine, dopamine, kidney transplantation, Cystatin C,
renal function